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Preoperative Serum Carcinoembryonic Antigen Level as a Prognostic Factor for Recurrence and Survival After Curative Resection Followed by Adjuvant Chemotherapy in Stage III Colon Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Carcinoembryonic antigen (CEA) is the most widely used tumor marker in colon cancer; however, there has been controversy regarding the significance of preoperative serum CEA level as a prognostic factor for recurrence. In this study, we evaluated the optimal cutoff value and prognostic significance of preoperative serum CEA level in stage III colon cancer.

Methods

Based on a retrospective cohort of 965 patients with stage III colon cancer who underwent elective curative surgery and adjuvant chemotherapy with fluoropyrimidine and oxaliplatin (training set), we determined the optimal cutoff value of CEA for recurrence using the Contal and O’Quigley method. We assessed the prognostic value of this cutoff value in terms of disease-free survival (DFS) and overall survival (OS) in a prospective cohort of 268 patients with stage III colon cancer (validation set). A Cox proportional hazards model was used to explore the association of prognostic variables with DFS and OS.

Results

The statistically determined best cutoff value for CEA was 3 ng/mL in the training set. A high CEA level (≥3 ng/mL) was associated with inferior DFS (hazard ratio [HR] 4.609, 95 % confidence interval [CI] 2.028–10.474) and OS (HR 3.956, 95 % CI 1.127–13.882) in the validation set, while multivariate analysis showed that a high CEA level was an independent risk factor for DFS and OS in both study subsets.

Conclusion

Preoperative serum CEA level is an independent prognostic factor for DFS and OS in patients with stage III colon cancer after curative resection and adjuvant chemotherapy.

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Acknowledgment

This work was supported by a grant from the National Research Foundation of Korea, which is provided by the Korean government (MSIP, 2015R1C1A1A01053547). We would like to thank Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for help with the illustrations, Su Kyoung Park (Medical Record Administrator, Analysis Division of Medical Record Team, Yonsei Cancer Center, Seoul, Korea), and Nayeon Park (Clinical Research Coordinator, Yonsei Cancer Center, Seoul, Korea) for help with the management of data.

Disclosures

Chang Gon Kim, Joong Bae Ahn, Minkyu Jung, Seung Hoon Beom, Su Jin Heo, Jee Hung Kim, Young Jin Kim, Nam Kyu Kim, Byung Soh Min, Woong Sub Koom, Hoguen Kim, Yun Ho Roh, Bo Gyoung Ma, and Sang Joon Shin declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Oncology, Yonsei Cancer Center, Seoul, Korea

    Chang Gon Kim MD, Joong Bae Ahn MD, PhD, Minkyu Jung MD, Seung Hoon Beom MD, Su Jin Heo MD, Jee Hung Kim MD, Young Jin Kim MD & Sang Joon Shin MD, PhD

  2. Department of Surgery, Yonsei Cancer Center, Seoul, Korea

    Nam Kyu Kim MD, PhD & Byung Soh Min MD, Phd

  3. Department of Radiation Oncology, Yonsei Cancer Center, Seoul, Korea

    Woong Sub Koom MD, PhD

  4. Department of Pathology, Yonsei Cancer Center, Seoul, Korea

    Hoguen Kim MD, PhD

  5. Graduate School of Medical Science and Engineering, KAIST, Daejeon, Korea

    Chang Gon Kim MD

  6. Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea

    Yun Ho Roh MS & Bo Gyoung Ma MS

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  1. Chang Gon Kim MD
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Correspondence to Sang Joon Shin MD, PhD.

Electronic Supplementary Material

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Supplementary material 1 (TIFF 295 kb) Scheme of the study population of the training set

10434_2016_5613_MOESM2_ESM.tif

Supplementary material 2 (TIFF 736 kb) The receiver-operating characteristic (ROC) curves for recurrence. (a) The optimal cutoff value of CEA (carcinoembryonic antigen) was determined using a Contal and O’Quigley method from the training set. This cutoff value (3 ng/mL) also yielded maximal sensitivity and specificity (sensitivity, 80.8%, specificity, 56.0%; area under ROC curve (AUC), 0.688). (b) The ROC curve indicated a cutoff value of 3 ng/mL in the validation set (AUC, 0.665; P < 0.001)

Supplementary material 3 (DOCX 30 kb)

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Kim, C.G., Ahn, J.B., Jung, M. et al. Preoperative Serum Carcinoembryonic Antigen Level as a Prognostic Factor for Recurrence and Survival After Curative Resection Followed by Adjuvant Chemotherapy in Stage III Colon Cancer. Ann Surg Oncol 24, 227–235 (2017). https://doi.org/10.1245/s10434-016-5613-5

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